On "All Fours"

Extraordinarily talented at sex and dancing, the 46-year-old narrator of All Fours – Miranda July, the same name as the book’s author – makes often-surprising discoveries about women’s midlife changes that offer relief and even inspiration. The most positive revelations come in response to a question the narrator poses to doctors and via open sourcing on social media: “What’s the best thing about life after bleeding?”

“I feel like my true self. Like I’m 9 years old and I can do whatever I want,” a former producer writes. And another says, “It’s become a joy to be unseen.” From the teacher of Miranda’s young son: “my chronic migraines stopped completely after menopause.” The narrator muses: “I couldn’t believe how quickly they were responding, as if they had been waiting for someone to ask this very question.”

In Miranda’s early research, the list of menopause symptoms “seemed to describe a horrible disease, possibly fatal.” Explanations from friends can be worse: on decreased libido, one said, “there’s no hormonal drive now so it all becomes mental. I have to create a narrative that makes [arousal] possible.”

The narrator’s first inklings come during an annual gynecological exam, which proceeds as usual until she mentions irregular bleeding. Immediately the doctor asks, “any hot flashes?” No. “Insomnia?” No – but, the narrator adds, “sometimes I wake up at two a.m. and can’t fall back asleep… most nights [for] a year or two.” Later she describes “emotions…like runaway trains.”

After blood tests, the doctor prescribes hormone replacement therapy -- estradiol cream along with progesterone – news not widely known about the recent return of U.S. doctors to prescribing HRT. Over the previous two decades, a flawed 2002 study had led to a dramatic drop in prescriptions for replacement hormones, known to treat menopause-related conditions, such as osteoporosis, and to reduce risks of heart disease and several cancers.

Along with a Mediterranean diet, the doctor advises exercise can help “reduce inflammation and protect your joints. And brain.” Months of arduous weight-lifting lead the narrator to discoveries unfamiliar to exercise-resistant readers: “the weight of my own body seemed less arduous. I floated around…”

HRT helps regulate the narrator’s stress – and her emotions become “ordinary trains;” also she sleeps “the whole night through.” What changes the most, though, Miranda says is that she “stopped worrying about hormones rising and libido waning…it was only my alarm that had vanished.”

The “best thing…after bleeding” question arises in a later appointment with the gynecologist – with her surprising answer, “A woman’s mental health postmenopause is usually better than it’s been at any other time in the life of that particular woman, other than maybe childhood.” Her first reason: women’s hormones -- estrogen, progesterone and FSH (follicle-stimulating hormone) --“aren’t cycling anymore.” But she adds: “And, of course, in a patriarchy your body is technically not your own until you pass the reproductive age.”

“Continuing the conversation women have had around All Fours,” according to the New York Times is the new film Babygirl – which offers “more than enough to begin titillating conversations about sex and desire.” London sex and relationship therapist Chantal Gautier told the Times, “These cultural moments can help people open up about their own lives…and lessen stigma.”

“We need to have more movies like this so we can talk about these topics,” said Gautier. Based on the movie’s opening scene – in which the main character “dashes away to masturbate privately after faking an orgasm with her husband” – men asked questions such as whether women really fake orgasms, one woman told the Times. Her answer: “It was like, ‘Yeah, we do.’”

For me, the best revelation from Miranda July’s “after bleeding” research was that, yes, I’d experienced these things — and, yes, they were good. At a certain point, I realized that people were not looking at my body, if they ever had been — and that being unseen is freeing. The narrator enticed me with her post weight-lifting sensations, though I have not yet gone to the gym. And the book reminded me of my prudishness -- during explicit sex scenes, when the narrator guided a man to remove her used tampon –- that I needed to keep working on that. Whatever I loved about the All Fours, I have more to do: accepting the positives, working on the challenges, and maybe one day even lifting weights.